Piriformis Syndrome: The Best 6 Exercises To Help Your Hip & Butt Pain

By Dr Ken Nakamura+

Piriformis Syndrome Can Give You Buttock Pain: Toronto Downtown Chiropractic

Do you have a pain in the butt that gets worse with sitting?

 

Does your buttock pain turn into sciatica or leg pain occasionally?

 

Have you been diagnosed with a disc herniation or piriformis syndrome?

 

In this article I show you the difference between herniated discs and piriformis syndrome then at the end show you the 6 exercises for piriformis syndrome.

 

 Piriformis muscle is deep inside your buttock which gets very tight and irritated when there is pressure on it, like when you are sitting. Your piriformis muscle ‘s job is to rotate your hip outward away from the body so you can shift your weight from one foot to another. The problem is it often get mixed up with herniated discs.

 

Both herniatied discs and piriformis syndrome can cause buttock pain and sciatica. It’s so easy to mix up that many doctors and chiropractors mix the two very similar diagnosis up. Most of them will diagnose a disc herniation, sacroiliac syndrome, and facet syndrome but rarely piriformis syndrome.

 

The problem is the treatment for disc herniation is different from piriformis syndrome treatment.

 

See Also: Your Guide To Disc Herniations & Disc Bulges

See Also: Best Self-Treatment For Your Disc Herniation

 

Piriformis Syndrome is not that rare. Today I will show you a couple tests that you can do yourself so that you can keep your chiropractor or medical doctor on the ball when they are diagnosing you.

 

Picture of sciatic nerve and piriformis muscle

 

Piriformis Syndrome Can Give You Buttock Pain: Toronto Downtown Chiropractic

Most of you (96%) have your sciatic nerve come out underneath the piriformis muscle as shown in the picture above. [1]  You can see the sciatic nerve but you can’t see that it is actually formed by 5 nerves that join together. The picture below shows nerves from the lower back and pelvis joining together to form the the sciatic nerve.

Sacrum and sacral nerves that form sciatic nerve

 

For the unlucky few though the sciatic nerve passes right through the piriformis muscle. This makes your piriformis muscle more vulnerable to pain. The piriformis muscle often gets tight naturally from sitting too much. We weren’t really designed to sit for so long and put so much pressure, on this muscle. When the muscle gets tight the nerve get irritated and causes a vicious circle of pain.

 

Tight Piriformis ->> Nerve Irritation->>Tighter piriformis ->> More Nerve Irritation

 

This vicious circle whatever the cause will likely make you feel pain in the buttock especially the hip area (2nd picture above) and right near the sacrum  (2nd picture above). You might even have difficulty walking.[2]

 

Tests For Piriformis Syndrome

 

The first key test to look for with piriformis syndrome is when you sit down. Lift your bad side foot onto the seat of the chair then bring your bad leg toward the opposite chest. You might feel some pain if you have another problem like a disc bulge. With piriformis syndrome this maneuver will give your buttock agonizing pain, or at least a lot more pain. [3-4] You might have pain in the hip area or right in the middle of the buttock or more toward the center of the pelvis, and even sciatica. This sign along with a number of other positive signs increases the likelihood that you have piriformis syndrome.

 See Also: MRI, CAT Scans & X-rays Your Guide

 

This minor test although not a key sign is, if you push on your own buttock and feel pain in the above areas it maybe a sign that you have piriformis syndrome. It is easier to lie down on your back with a tennis ball underneath your buttock.

 

The second key test is when you lie down on your back. Both of your feet should point upwards. If you find that on the side of your painful butt, your toes are going outward more you have a tight piriformis muscle. The piriformis’ job is to turn your hip out. When it’s really tight your foot will be forced to turn out. The real key is when you try to bring your toes back toward the center you will be faced with some pain. This further increases the chance that you have piriformis syndrome.[5-6]

 

The second minor test. Your tight piriformis can cause the sacrum to rotate and cause a short leg on the tight piriformis side.[7-8] Do you have a short leg on the side of your painful piriformis? This is a difficult one to tell but you can try by sitting on the floor with your legs straight out in front of you. Try to have your body straight and your arms in the exact same spot. Even your head should be looking straight ahead.

 

In the picture below you can see that the left foot is short.

Leg length difference: Piriformis Syndrome Can Affect Your Leg Length: Toronto Downtown Chriorpactic

http://www.maximumtrainingsolutions.com/Anatomical-Leg-Length-Inequality.html

 

X-rays and MRI For Piriformis Syndrome

X-rays and MRI won’t tell you if you have piriformis syndrome. They usually do more to persuade medical doctors and chiropractors that you have something other than piriformis syndrome. In other words X-rays and MRI can often mislead your health practitioner.

 

After finding a lot of the above tests that we talked about positive your chiropractor should have piriformis syndrome as one of the number of  possible diagnosis. Your chiropractor will do other tests to determine if the piriformis muscle is involved. Then they take an X-ray or MRI or a CAT Scan. That’s when things go wrong.

 

Most of you that are 40 years of age an older have degenerative disc disease. It might be mild or moderate. The report says degenerative disc disease, disc herniation or even osteoarthritis. The problem is these problems that are visible on X-ray don’t necessarily cause any pain.

 

See also: Degenerative Disc Disease: Remedies For Lower Back Osteoarthritis

 

See Also: Part 2 Exercises – Degenerative Disc Disease: Best Exercises To Help Your Lower Back Pain

 

 

 

Your X-ray report says you have moderate degenerative disc disease and you have sciatica that matches the  pinched nerve from degenerative disc disease. The X-rays have found your diagnosis right? Pictures of degenerative disc disease in some cases influence your medical doctor or chiropractor. Some may even disregard your exam finding or more commonly, they don’t do the other tests to begin with, letting the X-rays become the overriding factor instead of confirming a diagnosis that they previously had in their head. Your chiropractor or doctor in that case will miss the diagnosis.

 

If your chiropractor doesn’t think about a possible diagnosis they can’t do the test.

 

Keep in mind there are orthopedic tests that your chiropractor will use to help diagnose you. Since you can’t do them yourself I won’t go over those tests here.

 

Treatment for Piriformis Syndrome

 

#1 Piriformis Stretch: Seated

Piriformis stretch seated: For Piriformis Syndrome - Toronto Downtown Chiropractor

https://myhealth.alberta.ca/health/AfterCareInformation/pages/conditions.aspx?hwid=zp4551

 

  1. Sit in a sturdy chair.
  2. Cross your affected leg over your knee, resting your foot on top of your knee.
  3. Keep your back straight, and slowly lean forward until you feel a stretch in your hip.
  4. Hold for 30 seconds.

 

#2 Piriformis Stretch: Laying Down

Piriformis Stretch Supine: For Piriformis Syndrome - Toronto Downtown Chiropractor

  1. Lay down on your back.
  2. Cross the affected leg over other bent leg.
  3. Pull the unaffected leg towards you until you feel the stretch.
  4. Hold for 30 seconds 3 times.

#3 Stretch Your Hip Stabilizer: Gluteus Medius –  Pigeon Pose

Pigeon Pose Gluteus medius stretch: Toronto Downtown Chiropractic

  1. Start on all fours like a crawl position.
  2. Bring your right leg forward and bent with the other leg straight back.
  3. Reach out forward with your body till you feel it in your hips.

Do this for 30 seconds 3 times.

#4 Bridge Exercises: Strengthen your Gluts

This exercise is for those that are not quite ready for the next two exercises.

Degenerative Disc Disease Exercises Supine Plank: Downtown Toronto Chiropractic

 

  1.  Get on your back with your knees bent and hands down by your side.
  2. Lift up until your torso is straight like in the picture above.
  3. Go back down and as when you touch the floor, go back up again.

Do this exercise 15 times for 3 sets.

#5 Strengthen Your Hips: Squats

 

How to Improve Posture-Chair Squats: Toronto Chiropractic Clinic

  1. Stand in front of a chair with your knees shoulder width apart.
  2. Turn your toes out slightly
  3. Go to sit down leading with your buttock until your butt touches the chair.
  4. When your buttock touches the chair get back up again without resting.

Advanced: Don’t use a chair and go to 90 degrees.

 

# 6 Strengthen Your Hips: Lunges

Lunge Exercise For Piriformis Syndrome - Toronto Downtown Chiropractor

 

  1. Stand with your legs together and arms at your sides
  2. Step two to three feet (60-90 cm) forward with your left foot.
  3. Bend both of your knees to lower yourself into a lunge.
  4. Each knee should be 90 degrees. Keep your knee directly over your ankle so you don’t strain your knee.
  5. Push off with your left leg and return to the starting position.
  6. Repeat with your other leg.

Do this 10X on each leg. 3 sets should be fine.

If you have trouble doing this you can do a more shallow lunge by not going down as deep.

 

Tell us what you think in the comments below and like us on Facebook. I will answer all questions in the comments section here at this downtown Toronto Chiropractic clinic.

 

Research

1. 15. Beason LE, Anson B.J. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Record1937;70:1-5.

2. Lori A. Boyajian-O’Neill, DO et al, Journal of the American Osteopathic  Association, Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach

3. Chaitow L. Soft Tissue Manipulation: A Practitioner’s Guide to the Diagnosis and Treatment of Soft-Tissue Dysfunction and Reflex Activity. 3rd ed. Rochester, Vt: Healing Arts Press;1988 .

4. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am1999;81:941-949

5. TePoorten BA. The piriformis muscle. J Am Osteopath Assoc1969;69:150-160.

6. DiGiovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2005 .

7. Retzlaff EW, Berry AH, Haight AS, Parente PA, Lichty HA, Turner DM, et al. The piriformis muscle syndrome. J Am Osteopath Assoc1974;73:799-807

8.  Grant JH. Leg length inequality in piriformis syndrome. J Am Osteopath Assoc.1987;87:456 

9. Kevork Hopayian et al., The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. Dec 2010; 19(12): 2095–2109.

 

Note:
Piriformis is a pure abductor at 90 degrees knee flexion-Test resisted abduction
Piriformis at 60 degrees is external rotator - test resisted external rotation.

 


Author

Dr Ken Nakamura


65 Responses to Piriformis Syndrome: The Best 6 Exercises To Help Your Hip & Butt Pain
  • Sarah says:
    August 27, 2017 at 2:59 pm

    Hi there Dr Ken

    My son 24 has a pain in his butt cheek that is so painful it causes him to faint as he can’t walk.Day to day he is fine then it just comes on at night maybe once a week. He has to take a painkiller sleep and then he is fine again for a week…
    Do you think this could be this piriformis syndrome as the physio he is seeing just gives him stretches that make it worse?

    • Dr Ken Nakamura says:
      September 5, 2017 at 7:47 am

      Thanks for you question Sarah. First, the physio should figure out if the exercises are making him worse by the second visit. I can’t tell you if it’s piriformis syndrome as I don’t know what exercises make him worse and what activities make him worse etc…Let me know and I can give you an opinion.

  • Umesh says:
    August 5, 2017 at 10:57 pm

    Sir. I am Umesh from India. Sir I get some sort of irritation and pain when I walk in my balcony which requires changing direction every 10 steeps. Is is pirimosis syndrome? Which is the best position to sleep with pirimosis syndrome?

    • Dr Ken Nakamura says:
      August 10, 2017 at 6:53 pm

      Thanks for your question Umesh. Everything from a knee problem, hip, lower back problem to local muscles above or below the piriformis can cause your pain. Be specific and write about your what makes things worse eg. sitting, standing, walking, etc….

      I cannot give you an opinion otherwise.

  • JoeD says:
    January 20, 2017 at 2:02 am

    Fantastic report Dr. Nakamura. Some of the best info and easiest to comprehend. I had disc surgery, discectomy, 3 years ago. I spent 2 1/2 years in agony prior to the surgery. It was life changing. I had a herniated disc and a fragment, if I remember correctly. The surgeon told me it was the easiest of discectomies since the fragment was obvious and easily removed. Had 3 years of great health, minus the typical arthritic pain of an active 60 y.o. male. 2 months ago I spent 2 week in a 3′ crawl space working on radiant heat in all kinds of awful positions. One day I noticed a bit of sciatic pain return and within an hour it was full blown debilitating sciatica. After a few weeks of hot showers and ice packs I was at least able to function. I was sure I had a disc bulging but oddly I could bend without any lumbar pain. Web research brought me to your site and it was easy for me to realize it was my piriformis. Your descriptions and pictures were of the greatest help. I’ve been doing the recommended stretching for 2 weeks and the pain is almost completely gone, I can still find it if I try hard enough while stretching. Thank you, great work, I will recommend your site with great enthusiasm.

    • Dr Ken Nakamura says:
      January 20, 2017 at 3:21 am

      You are welcome Joe. Glad your piriformis syndrome is gone.

      • Rizwan sheikh says:
        November 7, 2017 at 9:37 am

        Sir i am rizwan sheikh from India l have 12 year old son. He has left leg short till1inch what type of exercise he should be do or other treatment for him to get better results which is safe for my child

        • Dr Ken Nakamura says:
          November 7, 2017 at 11:22 am

          Thanks for your question Rizwan. I recommend that you see a professional as there are many reasons for a short leg. The bone can be short for many reasons or the muscles can pull one leg shorter for many reasons such as the pelvic flexion and extension. You need to get the more serious conditions ruled out.

          Also, did the person who looked at the problem and determine this “short leg” have training. If they did they should have ruled out the other problems. They should also know the problem is. Also, it may not even be a problem depending on the size of the son. Most people have a short leg but not to that extent. Also, the measurement can be inaccurate and one leg is only 1/2 inch short which, depending on the height of the child put them within normal limits. Which means there really isn’t a problem.

          Hope that helps your child’s short leg. I will do my absolute best to answer your questions.

  • Amy says:
    January 18, 2017 at 3:58 am

    I’ve been doing stretches (just found your site and you have some that I have not tried – so I will be adding those to my routine tomorrow!) for about 2 weeks and I’m still in quite a bit of pain. I was diagnosed with piriformis by my pcp and offered no solution for the pain (wasn’t after pills – just want this to stop!). The stretches are helping some, I’m trying pilates and walking on the treadmill – which all help somewhat. I can deal without sitting most of the day, but I’m having a horrible time sleeping! I seem to aggravate it every night no matter what I do (pillow between the knees). Do you recommend sleeping in a recliner? How long should I expect to be dealing with this? I know everyone is different and you haven’t examined me – but maybe a ballpark figure so I can have something to work towards. This is really starting to get me down!

  • Dennis says:
    December 28, 2016 at 10:16 am

    Dr. Ken, thank you for your article. Your article confirms what I learned from another article yesterday. I seem to have all the classical signs of piriformis syndrome. I started doing the stretches you recommend yesterday. I had been doing inversions but read on another site they would make PS worse. Is that true?

    Thank you, Dennis

    • Dr Ken Nakamura says:
      December 31, 2016 at 7:44 pm

      Thanks for your question Dennis. If you are talking about an inversion machine it will not make piriformis syndrome any worse. It will have no effect at all. If you get worse or better, you more likely have a disc herniation as inversion will take pressure off the disc. When you stand again there is more pressure on the disc so you will feel pain. Then the pain should get better a little bit. This is an opinion and not a recommendation.

      Hope that helps your piriformis syndrome.

  • Priscilla says:
    December 8, 2016 at 3:11 am

    Can we walk fast or run on the treadmill even with this issue? What are the workouts to stay away from and what’s the best thing to do besides what you posted? Thank you

    • Dr Ken Nakamura says:
      December 14, 2016 at 9:42 am

      Thanks for your questions Priscilla. I wouldn’t run on the treadmill but a fast walk should be fine. Best thing is to do the stretches I posted.

      Hope that helps your piriformis syndrome.

  • Hanady says:
    November 14, 2016 at 6:01 am

    I left heavy wieght in may from earth with bad position and diagnosed as piriforms syndrome
    I know that it needs to be exmained clinically and very well
    While i do lunges i feeel pain under my glutes area or the doen of the gluteas area before the hamstring
    Is it pirformis kr sciatica?
    And is heavy lifting from earth cause pirformis injury

    • Dr Ken Nakamura says:
      November 16, 2016 at 10:10 am

      Thanks for your question Hanady. While lifting from the ground usually doesn’t cause piriformis to be injured. This very unlikely. You need to get yourself another health care practitioner. Perhaps a good chiropractor in your area will help more than the person you are seeing. If you are already seeing a chiropractor another chiropractor would be in order. That’s my opinion anyways. It’s not a recommendation.

      Hope that helps your buttock pain.

  • Jane says:
    April 3, 2016 at 6:50 pm

    Hi! I’m a 29 yr old mum of 2, with a son who is now 5 weeks old. During pregnancy I started to suffer from sciatica pain suddenly in the 8th month. I have a large hernia which has never caused sciatica ( even in my 1st pregnancy) although it already showed that it was pressing on nerves. Doctors straight away diagnosed this as my problem. The pain ( left glute/Left calf /foot-pain and pins and needles) became acute after labor. I did not have the tests you have mentioned carried out. An MRI confirmed the preexisting hernia which was still pressing on the nerve. I have seen a chiropractor and physiotherapy and have taken every nsaid under the sun aswell as steroid injections in the glute to no avail. When carrying out the sitting test you describe I have severe pain in the glute. My pain seems to now be centered in the glute as well as the groin and pelvis and hip area aswell as the tail bone area. I am unable to sit down at all due to the glute and sciatica pain and find more relief walking and moving around. Could this be periformis rather than the disc or a mix of both? Thankyou for your time

    • Dr Ken Nakamura says:
      April 7, 2016 at 9:56 pm

      Thanks for your question Jane. The only real way to find out is if you get your piriformis treated but not the disc and see if you get significantly better. Even with disc herniations when you treat the piriformis the disc herniation gets better but only part way.

      In your case though with all the symptoms all around the groin, the piriformis will not do that. Sounds more like a disc to me. I would have someone treat you for a disc and as part of the treatment they should be treating your piriformis anyways.

      Hope that helps your disc herniation.

  • Tarush Gupta says:
    December 27, 2015 at 6:09 pm

    Hi Ken. Your article is a good read. I have a doubt and I hope you can clarify. I have been a regular yoga student and I can do all yoga stretches including the ones you mentioned. But whenever I get up after sitting or standing or lying down , after 4-5 seconds I get a sharp pain in butts and calf which lasts for 3-4 seconds and then it goes away. I have no pain in back while bending forward. Doctors are confused between disc issue or pisiformis. I had MRI 4 years back and mild herniation was diagnosed but nothing major. Is my symptom common ? I don’t have continuos pain. Only 2-3 second pain after getting up from any static position.

    • Dr Ken Nakamura says:
      January 4, 2016 at 7:11 am

      Thanks for your question Tarush. You wouldn’t have trouble getting up from sitting, standing or lying down with piriformis syndrome but you can with disc herniations. It wouldn’t show up on MRI as even moderate disc herniations as most of the pressure on the disc is decreased when lying down to do an MRI.

      It’s not uncommon to have sharp pain initially when they load their spine.

      Hope that helps your likely disc herniation.

  • Julia says:
    December 9, 2015 at 7:15 pm

    Could you please post a photo of how to do the minor test for piriformas as I’m not sure what you mean by “put your bad leg on the chair and bring to opposite side of chest”.
    I have had lower back pain for years which I’ve never had improvement on evern with many chiropractic/physio visits – 3 years ago I had an MRI and they told me “degeneration between L4 and L5”. Recently, I’ve had a pain in my left buttock and extreme pain when I crouch down (i.e. have to hold onto something to get myself up). I am not overweight but in my mid 40’s.
    I’m wondering if I should suggest this piriformis thing to my Dr as she seems to have no clue what’s up with the pain in the back of my legs.
    Thank you!

    • Dr Ken Nakamura says:
      December 15, 2015 at 10:28 pm

      Thanks for your question Julia. It may be piriformis syndrome but not likely as you have pain in both legs. More likely you have disc herniation that is central and large but it can be a number of different diagnosis. The treatments are different for disc herniations and piriformis syndrome. So if your health practitioners didn’t diagnose it properly then they won’t get you better. Likely they didn’t give you the correct treatment as the diagnosis was not correct.

      Hope that helps your buttock and leg pain.

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